My PhD research focuses on prioritisation in the distribution of healthcare. Decisions concerning the reimbursement of healthcare from public funding are informed by e.g. information about patients’ disease severity and the (cost-) effectiveness of treatments.
In the Netherlands, ‘severity’ is quantified in terms of proportional shortfall; the proportion of disease-related loss in quality-adjusted life-years (QALYs), relative to the remaining QALY expectation in absence of the disease. In the applied decision-making framework, a relatively higher level of disease severity (and thus: proportional shortfall) is associated with a higher willingness to pay for treatment-related QALYs gained. If the level of proportional shortfall is, for example ‘low’, this is € 20,000 and if it is ‘high’, this is € 80,000 per QALY gained.
I examine whether proportional shortfall is a good measure for quantifying ‘severity’. Although there is general support for the use of proportional shortfall and it is increasingly used to inform priority-setting decisions in the Netherlands, my research indicates that it may be useful to correct proportional shortfall for age-related preferences in society. It appears that people (on average) have preference for reimbursing treatments for relatively younger patients, even when their disease severity is equal to or lower than that of older patients. A next step will be to examine whether people’s willingness to pay for QALYs gained depends on both patients’ disease severity and their age.
Although my research focuses primarily on proportional shortfall, I also examine societal views and preferences in relation to prioritisation in healthcare more broadly. For example, I have examined ‘whether’ and ‘how’ participation in a deliberative citizens panel on this topic influenced the views of participants.
Next to my PhD research, I work on the European Union Horizon 2020 COMED (‘pushing the boundaries of Costs and Outcomes analysis of MEDical technologies’) project. For this project, I work on the development of a taxonomy and manual for the use of Coverage with Evidence Development schemes for medical devices.
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